title: Massachusetts health care reform and reduced racial disparities in minimally invasive surgery.
abstract: OBJECTIVE
  Racial disparities in receipt of minimally invasive surgery (MIS) persist in the United States and have been shown to also be associated with a number of driving factors, including insurance status. However, little is known as to how expanding insurance coverage across a population influences disparities in surgical care.
  
  
  OBJECTIVE
  To evaluate the impact of Massachusetts health care reform on racial disparities in MIS.
  
  
  METHODS
  A retrospective cohort study assessed the probability of undergoing MIS vs an open operation for nonwhite patients in Massachusetts compared with 6 control states. All discharges (n = 167,560) of nonelderly white, black, or Latino patients with government insurance (Medicaid or Commonwealth Care insurance) or no insurance who underwent a procedure for acute appendicitis or acute cholecystitis at inpatient hospitals between January 1, 2001, and December 31, 2009, were assessed. Data are from the Hospital Cost and Utilization Project State Inpatient Databases.
  
  
  METHODS
  The 2006 Massachusetts health care reform, which expanded insurance coverage for government-subsidized, self-pay, and uninsured individuals in Massachusetts.
  
  
  METHODS
  Adjusted probability of undergoing MIS and difference-in-difference estimates.
  
  
  RESULTS
  Prior to the 2006 reform, Massachusetts nonwhite patients had a 5.21-percentage point lower probability of MIS relative to white patients (P < .001). Nonwhite patients in control states had a 1.39-percentage point lower probability of MIS (P = .007). After reform, nonwhite patients in Massachusetts had a 3.71-percentage point increase in the probability of MIS relative to concurrent trends in control states (P = .01). After 2006, measured racial disparities in MIS resolved in Massachusetts, with nonwhite patients having equal probability of MIS relative to white patients (0.06 percentage point greater; P = .96). However, nonwhite patients in control states without health care reform have a persistently lower probability of MIS relative to white patients (3.19 percentage points lower; P < .001).
  
  
  CONCLUSIONS
  The 2006 Massachusetts insurance expansion was associated with an increased probability of nonwhite patients undergoing MIS and resolution of measured racial disparities in MIS.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Loehrer
authors.affiliation: Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts3National Bureau of Economic Research, Cambridge, Massachusetts.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston.
authors.forename: Hugh G
authors.initials: HG
authors.lastname: Auchincloss
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hutter
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence*; D019538:Health Care Surveys; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage / Q000191:economics* / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult